Segal J B, McNamara R L, Miller M R, Kim N, Goodman S N, Powe N R, Robinson K, Yu D, Bass E B
The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
J Fam Pract. 2000 Jan;49(1):47-59.
Our goal was to determine what drugs are most efficacious for controlling the ventricular rate in patients with atrial fibrillation.
We conducted a systematic review of the literature published before May 1998, beginning with searches of The Cochrane Collaboration's CENTRAL database and MEDLINE.
We included English-language articles describing randomized controlled trials of drugs used for heart rate control in adults with atrial fibrillation.
DATA COLLECTION/ANALYSIS: Abstracts of trials were reviewed independently by 2 members of the study team. We reviewed English-language abstracts of non-English-language publications to assess qualitative consistency with our results.
Forty-five articles evaluating 17 drugs met our criteria for review. In the 5 trials of verapamil and 5 of diltiazem, heart rate was reduced significantly (P <.05), both at rest and with exercise, compared with placebo, with equivalent or improved exercise tolerance in 6 of 7 comparisons. In 7 of 12 comparisons of a beta-blocker with placebo, the beta-blocker was efficacious for control of resting heart rate, with evidence that the effect is drug specific, as nadolol and atenolol proved to be most efficacious. All 9 comparisons demonstrated good heart rate control with beta-blockers during exercise, although exercise tolerance was compromised in 3 of 9 comparisons. In 7 of 8 trials, digoxin administered alone slowed the resting heart rate more than placebo, but it did not significantly slow the rate during exercise in 4 studies. The trials evaluating other drugs yielded insufficient evidence to support their use, but those drugs may yet be promising.
The calcium-channel blockers verapamil or diltiazem, or select beta-blockers are efficacious for heart rate control at rest and during exercise for patients with atrial fibrillation without a clinically important decrease in exercise tolerance. Digoxin is useful when rate control during exercise is less a concern.
我们的目标是确定哪些药物对控制房颤患者的心室率最为有效。
我们对1998年5月之前发表的文献进行了系统综述，首先检索了Cochrane协作网的CENTRAL数据库和MEDLINE。
我们纳入了描述用于成人房颤心率控制药物的随机对照试验的英文文章。
数据收集/分析：试验摘要由研究团队的2名成员独立审查。我们审查了非英文出版物的英文摘要，以评估与我们结果的定性一致性。
45篇评估17种药物的文章符合我们的审查标准。在维拉帕米的5项试验和地尔硫䓬的5项试验中，与安慰剂相比，静息和运动时心率均显著降低（P<.05），在7项比较中有6项运动耐量相当或有所改善。在β受体阻滞剂与安慰剂的12项比较中有7项，β受体阻滞剂对控制静息心率有效，有证据表明该作用具有药物特异性，因为纳多洛尔和阿替洛尔被证明最有效。所有9项比较均显示β受体阻滞剂在运动期间能很好地控制心率，尽管在9项比较中有3项运动耐量受到影响。在8项试验中的7项中，单独使用地高辛使静息心率比安慰剂更慢，但在4项研究中，它在运动期间并未显著减慢心率。评估其他药物的试验产生的证据不足以支持其使用，但这些药物可能仍有前景。
钙通道阻滞剂维拉帕米或地尔硫䓬，或某些β受体阻滞剂对房颤患者静息和运动时的心率控制有效，且运动耐量无临床重要性降低。当运动期间的心率控制不太受关注时，地高辛是有用的。
